COVID-19 and The Surgical Neonate

COVID-19 pandemic in 2020-2021 affected millions of people including children. Though uncommon, there are few reports of COVID in neonates also. COVID is primarily managed by pediatricians;however, they are involved when providing anesthesia to these neonates for surgery. The role of anesthetists, besides during surgery, has proven to be vital in COVID pandemic for their expertise in airway and ventilatory management, also putting them to the highest risk of exposure. Various testing methods are available, and TrueNAT and RTPCR have emerged as most reliable. Most neonates remain asymptomatic or have mild symptoms;however, RTPCR testing should be done in all at least 72 h of preoperative. Utmost care should be taken during the preoperative evaluation, and in the perioperative period, goal is to prevent transmission of COVID to noninfected HCW involved in the perioperative period, to other newborns and neonates, and also to avoid increasing the severity of the diseases in the positive neonates, while keeping in mind the vulnerability of these babies in combination with their surgical disease and the changing neonatal physiology. COVID care protocols should be followed at all times. Anesthetic considerations remain the same as described in other chapters in the book, in newborns and neonates, both term and preterm. All OT personnel need to don the PPE, which can be problematic especially for the anesthetist, as it restricts the normal unhindered movements, use of stethoscope for chest auscultation for heart rate, respiration, and ETT positioning. Hence, one needs to be very meticulous in IV line and ET placement and their securing to prevent accidental dislodging during positioning and under the drapes. All disposable and non-disposable equipment used for the covid positive baby, should be adequately treated or discarded, as the case may be, after each surgery. Only emergency surgery should be undertaken in COVID-positive neonates to prevent high postoperative morbidity and mortality. There is not much data available in neonates, and most guidelines have been introduced for children and adolescents. Neonatal care has emerged from the experience of the anesthesiologist and from extrapolation of the available pediatric guidelines. Here, we will be discussing COVID in neonates and anesthetic management in COVID-positive neonates undergoing surgery. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Evaluation of a remote monitoring app in head and neck cancer follow-up care.

BACKGROUND: A remote monitoring app was developed for head and neck cancer (HNC) follow-up during the SARS-CoV-2 pandemic. This mixed-methods study provides insight in the usability and patients' experiences with the app to develop recommendations for future use. METHODS: Patients were invited to participate if they were treated for HNC, used the app at least once and were in clinical follow-up. A subset was selected for semi-structured interviews through purposive sampling considering gender and age. This study was conducted between September 2021-May 2022 at a Dutch university medical center. RESULTS: 135 of the 216 invited patients completed the questionnaire, resulting in a total mHealth usability score of 4.72 (± 1.13) out of 7. Thirteen semi-structured interviews revealed 12 barriers and 11 facilitators. Most of them occurred at the level of the app itself. For example, patients received no feedback when all their answers were normal. The app made patients feel more responsible over their follow-up, but could not fulfill the need for personal contact with the attending physician. Patients felt that the app could replace some of the outpatient follow-up visits. CONCLUSIONS: Our app is user-friendly, makes patients feel more in control and remote monitoring can reduce the frequency of outpatient follow-up visits. The barriers that emerged must be resolved before the app can be used in regular HNC follow-up. Future studies should investigate the appropriate ratio of remote monitoring to outpatient follow-up visits and the cost-effectiveness of remote monitoring in oncology care on a larger scale.

Manifestation of Headache Affecting Quality of Life in Long COVID Patients.

Objectives: The present study aimed to elucidate the characteristics of long COVID patients with headaches. Methods: A single-center retrospective observational study was performed for long COVID outpatients who visited our hospital from 12 February 2021 to 30 November 2022. Results: A total of 482 long COVID patients, after excluding 6, were divided into two groups: the Headache group of patients with complaints of headache (113 patients: 23.4%) and the remaining Headache-free group. Patients in the Headache group were younger (median age: 37 years) than patients in the Headache-free group (42 years), while the ratio of females (56%) in the Headache group was nearly the same as that in the Headache-free group (54%). The proportion of patients in the Headache group who were infected in the Omicron-dominant phase (61%) was larger than the proportions of patients infected in the Delta (24%) and preceding (15%) phases, and that trend was significantly different from the trend in the Headache-free group. The duration before the first visit for long COVID was shorter in the Headache group (71 days) than in the Headache-free group (84 days). The proportions of patients in the Headache group with comorbid symptoms, including general fatigue (76.1%), insomnia (36.3%), dizziness (16.8%), fever (9.7%), and chest pain (5.3%) were larger than the proportions of patients in the Headache-free group, whereas blood biochemical data were not significantly different between the two groups. Interestingly, patients in the Headache group had significant deteriorations of scores indicating depression and scores for quality of life and general fatigue. In multivariate analysis, headache, insomnia, dizziness, lethargy, and numbness were shown to be involved in the quality of life (QOL) of long COVID patients. Conclusions: The manifestation of headaches related to long COVID was found to have a significant impact on social and psychological activities. Alleviation of headaches should be a priority for the effective treatment of long COVID.

[Regional experience of a comprehensive dynamic assessment of the adolescents' health status with post-COVID-19 syndrome during aftercare in a sanatorium]. / Regional'nyi opyt kompleksnoi dinamicheskoi otsenki statusa zdorov'ya podrostkov s postkovidnym sindromom v period dolechivaniya v sanatorii.

OBJECTIVE: To determine the characteristics of sanatorium-resort therapy impact on children with post-COVID-19 syndrome of various severity, as well as to reveal association of its severity with family history data and genetic polymorphisms of alpha-1-antitrypsin-serpin-1 complex. MATERIAL AND METHODS: This 2-week retrospective cohort study involved 42 adolescents after new coronavirus infection (COVID-19). The first group included 28 (67%) patients (mean age 13.1±0.8 years) after mild COVID-19 (without confirmed coronavirus pneumonia), the second group - 14 (33%) patients (mean age 14.5±0.1.2 years) after moderate or severe disease (with confirmed coronavirus pneumonia). A complex of procedures, according to the approved standard, was prescribed for all patients admitted after outpatient and hospital treatment to the pulmonology department of the state children's sanatorium in order to aftercare. The certain follow-up parameters were evaluated: symptoms severity, life quality, respiratory function and respiratory gases, as well as family medical history and alpha-1-antitrypsin-serpin-1 complex. RESULTS: Patients after moderate and severe COVID-19 had initially lower and less dynamic growth of integral life quality index, more torpid follow-up rates of spirometry, pulse oximetry and exhaled gases. Additionally, the higher incidence degree of adverse family medical history associated with respiratory illnesses was established in the group after new coronavirus infection. Moreover, relatively more deficient alpha-1-antitrypsin and more frequent heterozygous polymorphism type of serpin-1 were found in the group after severe new coronavirus infection. CONCLUSION: The revealed complex of epigenetic and genetic factors may indicate various risk and development phenotypes of both acute and chronic respiratory diseases.

Tele-rehab aftercare.

Telerehabilitation applications are increasingly used in neurorehabilitation, especially since the SARS-CoV-2 pandemic. Their acceptance by care providers, patients and payers has increased. In the field of multiple sclerosis (MS), stroke and Parkinson's disease therapy, positive effects of telerehabilitation on various disease parameters have been demonstrated in smaller studies in recent years. The "non-inferiority"to outpatient rehabilitation measures has been shown convincingly in some rehabilitation patient collectives. In Germany, the Federation of German Pension Insurance Institutions (DRV Bund) has created an opportunity for the dissemination of telerehabilitative procedures by establishing tele-rehab aftercare.Copyright © Hippocampus Verlag 2023.

Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study.

BACKGROUND: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. OBJECTIVE: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. METHODS: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. RESULTS: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants' mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. CONCLUSIONS: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population.

Physical, social, mental and spiritual functioning of COVID-19 intensive care unit-survivors and their family members one year after intensive care unit-discharge: A prospective cohort study.

OBJECTIVE: To describe the long-term functioning of patients who survived a COVID-19-related admission to the intensive care unit and their family members, in the physical, social, mental and spiritual domain. DESIGN: A single-centre, prospective cohort study with a mixed-methods design. SETTING: The intensive care unit of the University Medical Center Groningen in the Netherlands. MAIN OUTCOME MEASURES: To study functioning 12 months after intensive care discharge several measurements were used, including a standardised list of physical problems, the Clinical Frailty Scale, the Medical Outcomes Study Short-Form General Health Survey, the McMaster Family Assessment Device, the Hospital Anxiety and Depression Scale, and the Spiritual Needs Questionnaire, as well as open questions and interviews with survivors and their family members. RESULTS: A total of 56 survivors (77%) returned the 12-month questionnaire, whose median age was 62 (inter-quartile range [IQR]: 55.0-68.0). Moreover, 67 family members (66%) returned the 12-month questionnaire, whose median age was 58 (IQR: 43-66). At least one physical problem was reported by 93% of the survivors, with 22% reporting changes in their work-status. Both survivors (84%) and their family members (85%) reported at least one spiritual need. The need to feel connected with family was the strongest. The main theme was 'returning to normal' in the interviews with survivors and 'if the patient is well, I am well' in the interviews with family members. CONCLUSIONS: One year after discharge, both COVID-19 intensive care survivors and their family members positively evaluate their health-status. Survivors experience physical impairments, and their family members' well-being is strongly impacted by the health of the survivor.

Actual status and future directions of cardiac telerehabilitation.

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the current COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.

Cancer care in German centers of excellence during the first 2 years of the COVID-19 pandemic.

PURPOSE: An increasing number of international studies demonstrate serious negative effects of the COVID-19 pandemic on the timely diagnosis of cancer and on cancer treatment. Our study aimed to quantitatively and qualitatively evaluate the capacities of German Comprehensive Cancer Centers (CCCs) in different areas of complex oncology care during the first 2 years of the COVID-19 pandemic. METHODS: Prospective panel survey over 23 rounds among 18 CCCs in Germany between March 2020 and June 2022. RESULTS: The COVID-19 pandemic substantially affected the oncological care system in Germany during the first 2 years. Persistent limitations of care in CCCs primarily affected follow-up (- 21%) and psycho-oncologic care (- 12%), but also tumor surgery (- 9%). Substantial limitations were also reported for all other areas of multidisciplinary oncological care. CONCLUSIONS: This study documents the limitations of oncological care during the COVID-19 pandemic and highlights the need to develop strategies to avoid similar limitations in the future.

How reconfiguration of a minor injuries unit has affected service delivery during the COVID-19 pandemic: a retrospective analysis.

INTRODUCTION: Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management. METHODS: Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C. RESULTS: Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged. CONCLUSION: Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.

Nurse Practitioner Follow-Up Care Using Telehealth MMSE

BACKGROUND: During the COVID-19 pandemic, many healthcare services moved to telehealth delivery for continuation of care. The Mini Mental Status Examination (MMSE) has been used for follow-up assessment of disease progression and care planning after dementia diagnosis. Carotentuto et al. (2018) found no difference in MMSE scores when repeating a telehealth MMSE two weeks after a face-to-face visit. The purpose of this study was to determine if telehealth cognitive testing (MMSE) is a reliable alternative to traditional face-to-face testing when nurse practitioners are providing follow-up care (every 6 months) for person with dementia and their families.

The Greifswald Post COVID Rehabilitation Study and Research (PoCoRe)-Study Design, Characteristics and Evaluation Tools.

(1) Background: COVID-19 is often associated with significant long-term symptoms and disability, i.e., the long/post-COVID syndrome (PCS). Even after presumably mild COVID-19 infections, an increasing number of patients seek medical help for these long-term sequelae, which can affect various organ systems. The pathogenesis of PCS is not yet understood. Therapy has so far been limited to symptomatic treatment. The Greifswald Post COVID Rehabilitation Study (PoCoRe) aims to follow and deeply phenotype outpatients with PCS in the long term, taking a holistic and comprehensive approach to the analysis of their symptoms, signs and biomarkers. (2) Methods: Post-COVID outpatients are screened for symptoms in different organ systems with a standardized medical history, clinical examination, various questionnaires as well as physical and cardiopulmonary function tests. In addition, biomaterials are collected for the analysis of immunomodulators, cytokines, chemokines, proteome patterns as well as specific (auto)antibodies. Patients are treated according to their individual needs, adhering to the current standard of care. PoCoRe's overall aim is to optimize diagnostics and therapy in PCS patients.

Chemsex, G&T, and The Club Drugs Clinic Ireland

Introduction: Chemsex refers to the intentional consumption of specific substances, Gamma Hydroxybutyrate/Gamma Butyrolactone (GHB/GBL), Crystal Methamphetamine and/or Cocaine to facilitate or enhance the sexual experience. However, there was a plethora of associated problems ranging in severity to complex, life-threatening situations. Since its inception in 2014, The Club Drugs Clinic Ireland, the first outpatient-based clinic for GHB/GBL Detoxification in Ireland, had evolved to include managing problematic chemsex. Objective(s): The Chemsex Working Group Ireland is a collaborative response from governmental and non-governmental agencies. Details of current medical and psychiatric management along with preliminary outcome findings on detoxification, relapse risk and associated factors will be presented. Method(s): Data collected include socio-demographic variables, gender and sexuality, detoxification setting, relapse history and attendance for counselling or aftercare. Descriptive analyses were conducted on referral counts, drug trends, success of first treatment episode, subsequent relapse rate, and uptake of counselling and aftercare. Result(s): There have been over 200 referrals to the Club Drugs Clinic Ireland. A number of predisposing and precipitating factors, contributed to the relapse rate (up to 70%) both in Ireland and internationally. The salutogenic, biopsychosocial-based model of addiction recovery produced the best outcomes. This integrated Dual Diagnosis Psychiatry, Sexual Health Medicine, Emergency Medicine and external services for a more comprehensive care. Conclusion(s): The pattern of referrals reflects population trends in chemsex, despite the COVID-19 restrictions. While detoxification is largely successful, the high relapse rate highlights the challenge of maintaining abstinence. In order to competently address problematic chemsex, service coordination across various medical professions and ongoing monitoring of the substances consumed is quintessential.

Remote Check Telehealth in Cochlear Implant Recipients: Personal Experience From COVID-19 Time to Routine Service

Introduction: To evaluate and validate the use of a remote check application in real life to enable cochlear implant (CI) recipients or parent/caregivers to monitor at home their progress and to help their clinicians to determine and plan for clinical visits based on their needs. Method(s): A total of 110 implanted patients (age range: 6-77 years;12-month implant experience and familiarity with vocabulary for digits 0 to 9) were included in this study, in which each subject served as their own control. The test battery includes an implant-site photograph, impedance measurements, datalogs, questionnaires, speech perception, and aided threshold tests. Chi-square test was used for statistical analysis of the results obtained at home vs clinical setting. Result(s): In all but 2 cases (108/110, 98%) the test battery reached the same conclusion as the clinician in determining whether the recipient required any clinical action. Of recipients and parents/ caregivers, 90% (100/110) reported being "satisfied" or "very satisfied" if their clinic visits were based on results from the selfadministered remote test battery (P<.001). Reasons for satisfaction included the convenience of remote monitoring, the ability to request an appointment if needed, and the continued involvement of their clinician. Satisfaction ratings with the remote monitoring concept were moderately to strongly correlated with perceived improvement in convenience and time involved. Conclusion(s): Most respondents recognized that the remote check battery has the potential to save time, reduce costs, and increase the convenience of aftercare. The clinicians with remote check battery are adequately informed regarding patient management, appointment scheduling, and required clinical actions. This may also further support global case management during COVID-19 pandemic time of recommended social distancing.

Effectiveness of the Incredible Years parenting program for children with behavioral problems: An experience in a developing country during a pandemic

• A parenting program established in a developed country could be transferred to a developing country with minimal adaptation, despite minimum resources and engagement barriers. • With some modifications, it is still feasible to deliver a group-based parenting program during a pandemic period. • A modified version of School Age BASIC Incredible Years parenting program was effective in improving both children and parental outcomes among children with clinical levels of behavioral problems. Although parenting programs have been supported as an effective family-based intervention for children's behavioral problems, they are underutilized in developing countries. This randomized controlled study aims to determine the effectiveness of the Incredible Years parenting program (IYPP) in improving behavioral problems in children, parenting stress, and parental mental health. Seventy mother–child dyads from three tertiary hospitals in Malaysia were divided into the IYPP and waitlist control groups. Weekly parent training sessions were adjusted during the pandemic period. Child's total difficulty scores of the Strength and Difficulty Questionnaire (SDQ-TDS), Parental Stress Scale (PSS) scores, and parental DASS-21 scores were measured at pre- and post-intervention, and follow-up, and analyzed using generalized estimating equation (GEE). Compared to the control group at baseline, the intervention group showed a 4.2- and a 3.5-point significantly lower SDQ-TDS at 2 weeks post-intervention and 3 months follow-up, respectively (B = -4.20, 95 % CI: −6.68, −1.72, p = 0.001;B = -3.51, 95 % CI:-6.37, −0.66, p = 0.016), a 5.0-point significantly lower PSS at 3 months follow-up (B = -5.03, 95 % CI: −9.16, −0.90, p = 0.017), and a 4.1-point significantly lower general stress scores at 2 weeks post-intervention (B = -4.06, 95 % CI: −7.20, −0.92, p = 0.011). Effect sizes were small (d s = 0.28–0.40). There was no significant intervention effect on maternal anxiety and depression scores. The modified parenting program was effective in improving children's behavior, parenting stress, and general stress among mothers of children aged 6–12 years presented with borderline and abnormal levels of behavioral problems, with sustained effects demonstrated for child behavior. However, the interpretation of these findings requires careful consideration of potential pandemic-instigated challenges and implications. [ FROM AUTHOR] Copyright of Children & Youth Services Review is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinical Outcomes in Exudative Macular Degeneration: A Prospective Study of Patients with Care Delay Due to the COVID-19 Pandemic

Purpose : During the emergeing COVID-19 pandemic, patient care was delayed due to clinic closures and patient hesitancy in seeking necessary care. We aimed to characterize clinical outcomes of exudative macular degeneration (AMD) patients who had delay in their care. As the uncertainly of the pandemic unfolds, this study aims to inform clinical decision making on future care delay decisions. Methods : Patients with a chart diagnosis of exudative AMD who had an appointment canceled from 3/16/20 through 5/4/20 were selected. This timeframe encompassed the official clinic closure and a time during which many patients self-delayed care. Patients with concurrent macular disease were excluded. Data from each ophthalmology encounter was collected from 3/1/2019 through 7/1/2021. A linear longitudinal multilevel model was used to model best-corrected visual acuity (BCVA) over time. Time varying covariates included injection at visit, presence of subretinal fluid, intraretinal fluid, geographic atrophy, and macular hemorrhage. Baseline covariates included age, race, sex, treatment interval, treatment vs. observation, delay interval, anti-VEGF agent, baseline subretinal fluid, intraretinal fluid, and geographic atrophy, prior PDT, and smoking status. Results : 161 eyes encompassing 2,555 ophthalmology encounters were selected. An initial model without addition of time varying or baseline predictors show a daily change in BCVA of 0.00151 logMAR (p = 0.05) over the study period. The pre-closure BCVA daily change was lower than the post-closure suggesting vision dropped at a faster rate after care delay, however this was not statistically significant (Figure 1). With time varying and baseline covariates added, intraretinal fluid status at baseline was the only statistically significant factor that predicted a larger BCVA slope (p=0.05). Conclusions : Initial data suggests that BCVA fell during the time period, but there was no significant difference between the pre-closure and post-closure data. Patients with intraretinal fluid at baseline may potentially have worse long-term visual outcomes if care is delayed. Further model refinement needs to be undertaken prior to any definite conclusions. (Figure Presented).

The Impact of a Text Messaging Service (Tonsil-Text-To-Me) on Pediatric Perioperative Tonsillectomy Outcomes: Cohort Study With a Historical Control Group.

BACKGROUND: Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child's surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement. OBJECTIVE: This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients. METHODS: Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents' Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used. RESULTS: In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t39=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t39=0.882; P=.38), emergency department visits (χ22=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). CONCLUSIONS: This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers' perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted.

Telepsychiatry During the COVID Pandemic: Reflection from India

Introduction: Recent advancements in information technology and access to smartphone have expanded the scope of healthcare delivery services across the globe. Telemedicine is making healthcare affordable and more accessible to the needy in situations like the present pandemic. Although telepsychiatry services were underutilised initially in India due to various barriers, its role in delivering healthcare services, has gained pace since the last few years. During the coronavirus disease (COVID-19) pandemic, India introduced telemedicine practice guidelines (March, 2020), and telepsychiatry operational guidelines (May, 2020), to remove barriers and promote equitable access. In the wake of COVID-19 pandemic various mental health institutes across India relied heavily upon telepsychiatry services to provide care. National Institute of Mental Health and Neuro Sciences, Bangalore being an Institute of National Importance has introduced different modules to provide clinical care to the mentally ill. Objectives: In this article, the authors provide an experiential account of various clinical services provided by our institute through telepsychiatry means across India during the COVID-19 pandemic. Conclusion: These clinical service modules have tremendous potential to increase the use of technology in providing quality care to the unreached population, bridging the treatment gap for psychiatric disorders globally and developing countries in particular.